The association between erosive toothwear and gastro-oesophageal reflux-related symptoms and disease: A systematic review and meta-analysis.

Jordão, Haydée W T; Coleman, Helen G; Kunzmann, Andrew T; McKenna, Gerry

OBJECTIVES To conduct a systematic review and meta-analysis to explore the association between erosive toothwear and gastro-oesophageal reflux disease or symptoms (GERD/S). SOURCES Electronic searches were performed in Scopus, Embase, and Web of Science databases for the identification of relevant studies, from 1980 until 2nd August 2019. STUDY SELECTION The review protocol was registered on PROSPERO (CRD42018096959) and the review was conducted according to PRISMA guidelines. Observational studies which examined the association between erosive toothwear, and GERD/S were included and categorised according to the use of objective or subjective measures of GERD/S. Where possible, odds ratios (OR) and 95% confidence intervals (CI) were derived and pooled in a meta-analysis. DATA 27 studies were considered relevant for the qualitative synthesis and 19 studies were pooled. Significantly increased odds of erosive toothwear were observed in individuals with GERD/S. This trend was more strongly associated with objectively measured GERD/S (OR 4.13, 95% CI 1.68-10.13), compared to subjectively measured GERD/S (OR 2.69, 95% CI 1.13-6.38). Whilst heterogeneity was very high these trends remained in most sensitivity and subgroup analyses conducted. CONCLUSION Individuals with GERD/S have a 2-4 fold increased odds ratio of also presenting with evidence of erosive toothwear compared with individuals who do not have GERD/S. CLINICAL SIGNIFICANCE This review suggests the need for a multidisciplinary medical and dental approach to managing individuals who present with erosive toothwear or GERD/S. Timely referrals between oral health services and gastroenterology should be considered as part of effective diagnosis and management.